The biomechanical modelling of non-ballistic skin wounding: blunt-force injury

Knowledge of the biomechanical dynamics of blunt force trauma is indispensable for forensic reconstruction of a wounding event. In this study, we describe and interpret wound features on a synthetic skin model under defined laboratory conditions. To simulate skin and the sub-dermal tissues we used open-celled polyurethane sponge (foam), covered by a silicone layer. A drop tube device with three tube lengths (300, 400, and 500 mm), each secured to a weighted steel scaffold and into which a round, 5-kg Federal dumbbell of length 180 mm and diameter 8 cm was placed delivered blows of known impact. To calculate energy and velocity at impact the experimental set-up was replicated using rigid-body dynamics and motion simulation software. We soaked each foam square in 500 mL water, until fully saturated, immediately before placing it beneath the drop tube. We then recorded and classified both external and internal lacerations. The association between external wounding rates and the explanatory variables sponge type, sponge thickness, and height were investigated using Poisson regression. Tears (lacerations) of the silicone skin layer resembled linear lacerations seen in the clinical literature and resulted from only 48.6% of impacts. Poisson regression showed there was no significant difference between the rate of external wounding for different sponge types (P = 0.294) or different drop heights (P = 0.276). Most impacts produced “internal wounds” or subsurface cavitation (96%). There were four internal “wound” types; Y-shape (53%), linear (25%), stellate (16%), and double crescent (6%). The two-way interaction height by sponge type was statistically significant in the analysis of variance model (P = 0.035). The other two-way interactions; height by thickness and sponge type by thickness, were also bordering on statistical significance (P = 0.061 and P = 0.071, respectively). The observation that external wounds were present for less than half of impacts only, but that nearly all impacts resulted in internal wounds, might explain the observed haematoma formation and contusions so often associated with blunt-force injuries. Our study also confirms the key role of hydrodynamic pressure changes in the actual tearing of subcutaneous tissue. At the moment and site of impact, transferred kinetic energy creates a region of high pressure on the fluid inside the tissue. As a result of the incompressibility of the fluid, this will be displaced away from the impact at a rate that depends on the velocity (or kinetic energy) of impact and the permeability and stiffness of the polymeric foam and skin layer.     

Distribution of HIV type 1 (HIV-1) in blood components: detection and significance of high levels of HIV-1 associated with platelets

BACKGROUND: Although inactivation of enveloped viruses transmitted by plasma derivatives has been successful, no methods for virus inactivation or removal have been established for platelet concentrates or red cell (RBC) components. Relatively little is known regarding the extent or significance of virus interactions with the cellular constituents in these components. STUDY DESIGN AND METHODS: Units of whole blood were collected from six HIV type 1 (HIV-1)-positive, asymptomatic individuals and separated into peripheral blood mononuclear cells (PBMNCs), cell-free plasma, white cell-reduced platelet concentrate, and white cell-reduced RBCs. DNA and RNA polymerase chain reaction and virus culture methods were used to study the compartmentalization of HIV-1 immediately after component preparation and after storage. RESULTS: As expected, HIV DNA and infectious virus were detected in fresh blood and in PBMNCs, and virion- associated RNA was detected in fresh plasma from all six donors. The levels of viral nucleic acids in these preparations remained relatively stable with 4 degrees C storage, whereas infectivity of PBMNCs was rapidly lost. Washed RBCs tested negative for HIV in all assays at all time points. Platelets retained high levels of HIV RNA (but not infectivity) after extensive washing, as well as after storage at 4 and 22 degrees C. High-level platelet-associated HIV-1 was also demonstrated in samples collected during early seroconversion. Periseroconversion and postseroconversion levels of platelet-associated HIV-1 correlated with the level of plasma viremia and with the rate of progression to AIDS. Cell-free virus from donor plasma and tissue culture fluid rapidly and firmly attached to platelets from noninfected donors. Infectivity of tissue culture virus bound to platelets was demonstrated in vitro. CONCLUSION: Significant levels of HIV-1 are associated with platelets during all stages of infection. Platelet- associated HIV could either mediate virus clearance or facilitate virus dissemination and expanded tropism. Finally, virus inactivation research must address virus associations with platelets.     

Detection of the active components of calf thymus nuclear proteins (TNP), histones that are binding with high affinity to HIV-1 envelope proteins and CD4 molecules

VGV-1, a clinical-grade formulation of bovine thymus nuclear protein (TNP) has been demonstrated to possess anti-viral activity in HIV-1 patients in five clinical trials, one of which was placebo controlled double-blinded. However, to date molecular mechanisms remain to be identified. Using surface plasmon resonance we observed TNP components bind with high affinity to HIV-1 proteins involved in viral entry, gp41 and pg120, as well as the T cell HIV-1 receptor CD4. To identify protein components of TNP, gel electrophoresis was performed followed by tandem mass spectrometry (MS/MS). Searching of bovine protein databases revealed the presence of numerous histones. Further analysis of TNP by immunoaffinity chromatography using gp120 and CD4 molecules as targets followed by gel electrophoresis and MS/MS analysis confirmed these data, demonstrating that H1.1, H2B, H4, and H2A histones are the active component of TNP that bind to HIV envelop glycoprotein and its receptor. To conclusively demonstrate binding of histones to target proteins, we repeated the surface plasmon resonance experiments using commercially available bovine histones and demonstrated high-affinity interaction of histones with gp120, and CD4. The binding of histone proteins to CD4, as well as viral molecules has profound implications for basic understanding of immune functions as well as a possible mechanism of VGV-1 activity in AIDS patients.     

Therapeutic alternatives in the management of osteoradionecrosis of the jaws. Systematic review

Background to systematically review the literature, comparing the healing of osteoradionecrosis (ORN) among the therapeutic alternatives: surgical, pharmacological and combined. Material and Methods The review was organized according to the PRISMA protocol with regards to the following PICO question: patients with ORN of the jaws (P=Patient); all interventions reported (I = intervention); between all therapies (C=Comparison); healing of lesions (O=outcome). Results Surgical treatment was the most common choice (46.3%) followed by pharmacological treatment, exclusively (25.9%) or combined (26.9%). Treatment exclusively by surgical intervention seems to be most effective option, with 51.2% of the lesions healed, OR for healing of 5.7 (CI95% 1.9-16.9, p=0.002). Only 1 case (0.9%) corresponded to low level laser therapy. Conclusions It seems clear that early intervention with conservative surgical combined with pharmacological methods improves the prognosis of ORN. Key words:Osteoradionecrosis, radiotherapy bone necrosis, hyperbaric oxygen, pentoxifylline, teriparatide, low level laser therapy.     

The Next Generation of Burns Treatment: Intelligent Films and Matrix, Controlled Enzymatic Debridement, and Adult Stem Cells

We describe a novel technology based on nanoengineered multifunctional acellular biologic scaffolds combined with wound dressings and films of the same kind. This method allows selective delivery and release of shielded biomaterials and bioactive substances to a desired wound or damaged tissue while stimulating the selective anchoring and adhesion of endogenous circulating repairing cells, such as mesenchymal stem cells, to obtain a faster and more physiologic healing process. We also present a new controlled enzymatic debridement process for more effective burned tissue scarolysis. In light of our preliminary in vitro and in vivo data, we are convinced that these approaches can include the use of other kinds of adult stem cells, such as endometrial regenerative cells, to improve the vascularization of the constructs, with great potential in the entire tissue and organ regeneration field but especially for the treatment of severely burned patients, changing the way these lesions may be treated in the future.